Provider Demographics
NPI:1659777969
Name:DELPORTO, LEAH NELSON (LMT)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:NELSON
Last Name:DELPORTO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 S 600 E
Mailing Address - Street 2:7C
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1999
Mailing Address - Country:US
Mailing Address - Phone:801-906-3222
Mailing Address - Fax:
Practice Address - Street 1:150 S 600 E
Practice Address - Street 2:7C
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1999
Practice Address - Country:US
Practice Address - Phone:801-906-3222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-13
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8015236-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist